Wk 5, Case 2 - Review

HISTORY: 40 year old woman presented with palpable right breast mass.

Summary of prior imaging:

Mammography: Obscured 3.0 cm mass right breast 6:00 posterior depth
Ultrasound: None
Breast MRI: None

FINDINGS

Quality control issues: ☒None ☐Poor/lack contrast bolus ☐Poor fat suppression
☐Susceptibility ☐Movement ☐Other

Background Parenchymal Enhancement: Moderate
Amount of Fibroglandular Tissue: Extreme fibroglandular tissue

LEFT BREAST

Narrative
There is a 1.3 cm benign-appearing enhancing mass in the 11:00 middle depth. There are no suspicious enhancing masses. No axillary or internal mammary lymphadenopathy is seen. There is no abnormal skin, nipple, or pectoralis muscle enhancement.

Left breast lesion 1
Lesion type: Mass
1.3 cm. Upper inner Quadrant. 11:00 Radian. 6.0 cm from the nipple

Mass/post-surgical change: Shape:Oval/lobulated. Margins:Circumscribed. Enhancement: Homogenous. Kinetics: delayed-Progressive

Associated findings LEFT: ☒NONE, ☐Nipple retraction, ☐Nipple involvement, ☐Skin retraction, ☐Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory, ☐Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion

Non-enhancing findings LEFT: ☐NONE, ☐High ductal signal pre contrast T1, ☒Cyst(s), ☐Hematoma/seroma, ☐Post therapy skin/trabecular thickening, ☐Non-enhancing mass, ☐Architectural distortion, ☐Signal void from clips

Fat containing lesions LEFT: ☒NONE, ☐Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat

Lymph nodes LEFT: ☒Normal axillary, ☐Abnormal axillary, ☐ Abnormal internal mammary

RIGHT BREAST

Narrative
There is a 3.0 cm irregular heterogeneously enhancing mass 6:00 posterior depth containing a biopsy marker clip with susceptibility artifact. There is right internal mammary lymphadenopathy, the largest of which measures 2.9 cm. There are T2 bright oval masses in the middle depth consistent with simple cysts, the largest of which measures 1.5 cm. There is a 0.8 cm T2 bright, fat-containing mass in the right breast 7:00 middle depth likely fat necrosis.
There are no suspicious areas of non-mass enhancement. No axillary lymphadenopathy is seen. There is no abnormal skin, nipple, or pectoralis muscle enhancement.

Right breast lesion 1
Lesion type: Mass
3.0 cm. 6:00 Radian. 8.3 cm from the nipple

Mass/post-surgical change: Shape:Irregular. Margins:Not circumscribed-spiculated.
Enhancement: Heterogenous. Kinetics: delayed-Washout

Associated findings RIGHT: ☒NONE, ☐Nipple retraction, ☐Nipple involvement, ☐Skin retraction, ☐Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory, ☐Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion

Non-enhancing findings RIGHT: ☐NONE, ☐High ductal signal pre contrast T1, ☒Cyst(s), ☐Hematoma/seroma, ☐Post therapy skin/trabecular thickening, ☐Non-enhancing mass, ☐Architectural distortion, ☒Signal void from clips

Fat containing lesions RIGHT: ☒NONE, ☐Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat

Lymph nodes RIGHT: ☐Normal axillary, ☐Abnormal axillary: description, ☒ Abnormal internal mammary: IMLN present, the largest of which measures 2.9 cm

Extramammary findings: None

SUMMARY: Biopsy-proven right breast cancer with ipsilateral internal mammary adenopathy

LEFT BI-RADS: 2: Benign: Routine breast MRI screening if cumulative lifetime risk =>20%
RIGHT BI-RADS: 6: Known biopsy-proven malignancy: Surgical excision when clinically appropriate

RECOMMENDATIONS: Referral for multidisciplinary evaluation and care, in this case neoadjuvant chemotherapy.